Return to School: A guide to responding to January 13, 2022 - Fresno County
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Return to School:
A guide to responding to
COVID-19 cases in
K-12 school settings.
2021-2022
January 13, 2022
Fresno County Department of Public Health.
1Return to School: A guide to responding to
COVID-19 cases in K-12 school settings
NOTICE: UPDATE January 13, 2022
All of our schools are directly impacted by the Omicron-fueled COVID-19 surge that has resulted
in the highest case rates of the entire pandemic. The response to Omicron is evolving rapidly.
On January 12, the California Department of Public Health (CDPH) released its updated K-12
School Guidance: https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/K-12-
Guidance-2021-22-School-Year.aspx
• Sections 7-9 have been updated- re Quarantine Recommendations
• CDPH has also developed an alternative approach to Quarantine described in Group-
Tracing Approach to Students Exposed to COVID-19 in a K-12 setting.
In addition, CDPH has updated its Isolation and Quarantine Guidance for the General Public:
CDPH Isolation and Guidance
To respond to these updates, K-12 schools in Fresno County may continue to follow the
recommendations in the Fresno County Department of Public Health (FCDPH) K-12 Guidance
below - which have not yet been updated but will be revised in the near future to incorporate
these changes, or the CDPH guidance referenced above.
FCDPH further recommends that students and staff at all schools use well-fitting masks (KN95
or N95), be fully vaccinated and boosted when eligible, and STAY HOME if sick until
asymptomatic and test negative for COVID-19.
This document was designed to provide guidance for Fresno County K-12 schools in response
to COVID-19 related scenarios. As students return to school and in-person instruction resumes
without any physical distance requirements, we recognize the importance of protecting the
health and safety of our students, school staff, and community. The goal of this document is to
help school staff respond to different scenarios and cases of COVID-19. Fresno County
Department of Public Health (FCDPH) also advises schools to prepare plans for remote
instruction for students who may need to isolate or quarantine or in the event of class or school
closures related to outbreaks. This document is applicable to all K-12 schools, public or private,
throughout Fresno County.
The following guidance is included in this document:
• COVID-19 Prevention and Best Practices
• COVID-19 School Scenario Guidance
• Guidelines for COVID-19 Exposure Scenarios for Schools
We will continue to revise these documents as necessary and as guidance from the California
Department of Public Health and CDC is updated, in particular:
Guidance for COVID-19 Prevention in K-12 Schools | CDC
K-12 Guidance 2021-22 School Year (ca.gov)
Guidance for the Use of Face coverings (ca.gov)
COVID-19 Emergency Temporary Standards Frequently Asked Questions (ca.gov)
2COVID-19 Prevention & Best Practices for Schools
Fresno County Department of Public Health’s Best Practices
• Post or perform screening for recent COVID-19 positive close contact or COVID-19
symptoms for all students upon entry into first classroom of the day, AND for all staff,
volunteers, or others when entering school buildings.
• Implement universal face coverings while indoors and on public transportation for all
students, teachers, staff, volunteers, etc.
• Although masks are optional while outdoors, masks are recommended when unable to
maintain physical distancing
• Availability of hand sanitizer at all entrances and commonly visited locations.
• Practice physical distancing in all indoor and outdoor settings when possible, particularly
when not wearing face coverings such as in cafeterias.
• Assess and address adequacy of ventilation in all indoor school settings.
• Maximize space between students and between students and the driver on school buses,
and open windows and keep air circulation open to outside air to the greatest extent
practicable.
• For activities where physical distancing is difficult to maintain we recommend:
o students stay with their class cohorts
o limit these activities to 15 minutes or less
o stay outdoors as much as possible
• Maintain capacity for isolation of symptomatic students in a room with a separate entrance
when students are on campus, with staff with appropriate PPE immediately available.
• Cleaning all high use surfaces at least daily.
• Minimize opportunities for contact where students/staff may congregate, i.e., start/end of
the school day, lining up for lunch, etc.
3Guidelines for COVID-19 Exposure Scenarios for Schools
This following is guidance for steps to take in response to confirmed and suspected positive cases on your school
campus.
Scenario Response and Isolation Steps Communication and Contact
Tracing Steps
1. Student has Student to remain at home for 10 days with at least 24 School to identify close contacts
tested positive for hours of no fever and resolution of symptoms. If in the two days prior to the day
COVID-19. asymptomatic, the 10 days begins on the date the student the positive test was collected OR
was tested which is day 0 of the 10-day isolation period. If to symptom onset, up to the time
symptomatic, the 10 days begins on the day the symptoms the student was last in class.
began which is day 0 of the 10-day isolation period. School to send notification letter
to all close contacts.
If symptoms persist beyond 10 days, student to remain at
home until at least 1 day after symptoms have resolved Advise ALL household and close
without the use of medication. contacts to quarantine for 10
days from the date of last contact
Identify locations where the index case spent more than 15 which is day 0 of the quarantine
minutes over a 24-hour period in the two days prior to the period and continue to wear a
day the positive test was collected OR to symptom onset: mask while indoors through Day
classroom, library, cafeteria, school bus, etc. If these 14 and self-monitor for COVID-
locations have not been cleaned and disinfected since the 19 symptoms through Day 14. If
student was present, close off areas used by the person who symptoms occur during this
is sick and do not use those areas until after cleaning and period, immediately self-isolate
disinfecting, wait as long as possible (at least several hours) and contact their local public
before you clean and disinfect. health department or licensed
healthcare provider and seek
evaluation and testing.
When both parties (index and
close contact) were wearing a
mask in the indoor classroom
setting, unvaccinated students
who are close contacts (more
than 15 minutes over a 24-hour
period within 0-6 feet indoors)
may undergo a modified 10-day
quarantine as follows. They may
continue to attend school for in-
person instruction if they:
i. Are asymptomatic;
ii. Continue to appropriately
mask, as required;
iii. Undergo at least twice
weekly testing during the
10-day quarantine
To discontinue quarantine before
14 days following last known
exposure, asymptomatic close
contacts must:
i. Continue daily self-
monitoring for symptoms
through Day 14 from last
known exposure; AND
ii. Follow all recommended
non-pharmaceutical
4interventions (e.g.,
wearing a mask when
around others, hand
washing, avoiding
crowds) through Day 14
from last known
exposure.
iii. If any symptoms develop
during this 14-day
period, the exposed
person must immediately
isolate, get tested and
contact their healthcare
provider with any
questions regarding their
care.
Alternatively, modified quarantine
or quarantine can end for close
contacts and household members
after Day 7 if a diagnostic
specimen is collected on or after
Day 5 from the date of last
exposure and tests negative if
they:
i. Are asymptomatic;
ii. Continue to appropriately
mask, as required.
If close contact is fully vaccinated,
see #2 below.
If other school-aged children are
in the household, notify their
respective school sites.
In consideration of data indicating
very few close contacts who are
tested have positive results, and
the challenges associated with
large-scale contact tracing and
the subsequent testing associated
with modified quarantine
protocols, schools may defer
contact tracing in the following
circumstance:
There is a single positive case in a
classroom or extracurricular
activity and all other students and
staff in the classroom or
extracurricular activity are masked
i. If a second positive case
in the same classroom
or extracurricular
activity see Scenario 14.
ii. If there are other
symptomatic students in
the same classroom or
5extracurricular activity
see scenarios 6 and 7.
iii. If positive case is a staff
member, see scenario 9.
Regardless of which option is
chosen;
Notify FCDPH liaison, and,
Notify school community
including staff and parents of a
new positive case. Notification to
indicate the date the school was
informed of the positive case and
the number of new positive cases
that day without releasing
information that would identify
whether the positive case was a
student or staff member or what
grade or class was involved.
2. Student or OK to stay in school without
teacher or staff additional restrictions if remain
person or asymptomatic. Recommend
volunteer testing for COVID-19 5-7 days
(employee) is fully after exposure, even if no
vaccinated or if 90 symptoms. Fully vaccinated close
days or less since contact or close contact with
confirmed positive documented COVID-19 in the last
COVID-19 but is a 90 days should wear a mask
close contact. indoors in public for 14 days
following exposure or, if tested,
until test result is negative and
isolate as described in #1 for 10
days if test result is positive.*
If vaccinated close contact or
close contact with documented
COVID-19 in the last 90 days
becomes symptomatic, follow
guidance for symptomatic
students or employees in this
document.
This guidance applies to close
contacts who are household
members as well.
*When You’ve Been Fully
Vaccinated | CDC
3. Student is a Recommend quarantine for close
close contact while contacts as described in #1 above.
wearing a mask
when index case
not wearing a
mask.
4. Student is a Recommend quarantine for close
close contact while contacts as described in #1 above.
not wearing a
6mask when index
case was wearing
a mask.
5. Teacher or staff Follow CalOSHA ETS guidance for
person or close contact:
volunteer (school The school must exclude
employee) is an from the workplace
unvaccinated close unvaccinated employees
contact. who had a close contact
until the applicable return
to work criteria are met.
(An exception applies if the
employee had COVID-19 in
the preceding 90 days and
has remained symptom
free.) If the unvaccinated
employee had no
symptoms, they may return
to work when 10 days have
passed since the last
known close contact. If the
employee developed any
symptoms, the person can
be returned if they either
meet the criteria required
to return a COVID-19 case,
or the person (1) tested
negative using a PCR test
after the onset of
symptoms, and (2) waited
10 days following the last
known close contact and
(3) has been symptom-free
for at least 24 hours
without fever reducing
medications.
6. Student Student to remain at home for 10/1 or if symptoms persist Recommend student follow up
becomes ill off beyond 10 days, for at least one day after symptoms resolve with physician for evaluation and
school campus without the use of medication. OK to return to school if test testing.
and is waiting for negative for COVID-19 (PCR or rapid antigen) AND
test results. symptoms have resolved for at least one day, OR if test Notify student’s family that other
negative for COVID-19 (PCR or rapid antigen) AND school-aged household contacts
symptoms do not include fever, cough, or shortness of should not return to school for
breath, OR if a licensed health care provider determines that 10 days from last contact with
symptoms are not new, or worsening based on a chronic index case. Household contacts
medical condition OR if a licensed health care provider has may end quarantine if student
made an alternative diagnosis based on a diagnostic test who is index case may return to
such as a positive strep screen or a positive screen for school based on criteria
influenza. described here AND household
contacts have been asymptomatic
for at least one day.
Notify classroom teacher and
advise teacher to monitor other
students for symptoms.
7If second confirmed or suspected
case in classroom, school to
identify close contacts in
classroom and other school
settings in the two days prior to
illness up to the time the student
was last in class, including key
contributing factors. Identify close
contacts with symptoms and
advise them to follow guidance in
#6, or if asymptomatic, begin
modified quarantine or quarantine
as described in #1 and notify
FCDPH liaison.
If student or close contact test
positive for COVID-19, identify
and notify close contacts, as well
as school community, and FCDPH
liaison as described in #1.
7. Student Place student in isolation room with separate entrance until Recommend student follow up
develops COVID- transported home or to higher level of care. More than one with physician, nurse practitioner,
19 symptoms student may be placed in isolation room if all masked and or other licensed medical
while at school. physically distanced as much as possible. If unable to professional practicing under the
maintain six feet distance from index case, staff person with license of a physician for
full PPE (N95 or higher mask, goggles/eye protector, gown, evaluation and testing.
and gloves) must be immediately available to evaluate or
assist student if necessary or arrange for prompt transfer to Notify student’s family that all
appropriate level of care. household contacts should follow
quarantine recommendations as
Student may be accompanied while moving from classroom described in #1. Household
or other school site to isolation room by staff person with contacts may end quarantine if
face covering AND observing physical distancing protocols. If index case tests negative for
closer contact required, staff person with full PPE must COVID-19 AND household
accompany child to isolation room. contacts have been asymptomatic
for at least one day without the
Isolation room to be cleaned and sanitized after symptomatic use of medication OR if a licensed
student leaves. Room cannot be re-used until cleaning and health care provider determines
disinfecting completed. that symptoms are not new, or
Student to remain at home for 10/1 or if symptoms persist worsening based on a chronic
beyond 10 days, for at least one day after symptoms resolve medical condition OR if a licensed
without the use of medication. OK to return or remain in health care provider has made an
school if test negative for COVID-19 (PCR) AND symptoms alternative diagnosis based on a
have resolved for at least one day, or if test negative for diagnostic test such as a positive
COVID-19 with either PCR or rapid antigen and evaluated by strep screen or a positive screen
a licensed health care provider AND symptoms have for influenza.
resolved for at least one day without the use of medication
OR if a licensed health care provider determines that Notify classroom teacher and
symptoms are not new, or worsening based on a chronic advise teacher to monitor other
medical condition OR if a licensed health care provider has students for symptoms.
made an alternative diagnosis based on a diagnostic test
such as a positive strep screen or a positive screen for If second confirmed or suspected
influenza. case in classroom, school to
identify close contacts in
classroom and other school
settings in the two days prior to
illness up to the time the student
was last in class, including key
8contributing factors. Identify close
contacts with symptoms and
advise them to follow modified
quarantine or quarantine
guidance as described in #1 and
notify FCDPH liaison.
If student tests positive for
COVID-19, identify and notify
close contacts, school community,
and FCDPH liaison.
8. Member of Student, and ALL household contacts, including other If student in same household
student’s school-aged household contacts, need to quarantine and not becomes symptomatic, refer to
household tests return to work or school for 10 days from date of last scenario #6 or #7 above. If
positive. contact with index case during index case isolation period. student tests positive for COVID-
19, refer to scenario #1 above.
Alternatively, quarantine can end after Day 7 if a diagnostic
specimen is collected after Day 5 from the date of last Notify school community
exposure and tests negative as described in #1. including staff and parents of a
new positive case. Notification to
indicate the date the school was
informed of the positive case and
the number of new positive cases
that day without releasing
information that would identify
whether the positive case was a
student or staff member or what
grade or class was involved.
9. Teacher or staff Follow CalOSHA ETS. School employee to remain at home School to identify close contacts
or volunteer for 10/1. If asymptomatic, the 10 days begins on the date in the two days prior to the day
(school employee) the teacher was tested. If symptomatic, the 10 days begins the positive test was collected OR
tests positive. on the day the symptoms began. to symptom onset, up to the time
If symptoms persist beyond 10 days, teacher to remain at the teacher was last in class.
home until at least1 day after symptoms have resolved School to send notification letter
without the use of medication. to all close contacts.
If not cleaned and disinfected since teacher was last in class Advise ALL household and close
or in any other school setting for 15 minutes or more over a contacts to follow quarantine or
24-hour period since the two days prior to testing positive modified quarantine as described
or becoming symptomatic, close off areas used by the in #1. If symptoms occur,
person who is sick and do not use those areas until after immediately self-isolate and
cleaning and disinfecting, wait as long as possible (at least contact their local public health
several hours) before you clean and disinfect. department or physician, nurse
practitioner, or other licensed
medical professional practicing
under the license of a physician
and seek evaluation and testing.
If there are school-aged children
are in the household, notify their
respective school sites.
Notify FCDPH liaison.
If no violations of local or state
health officer orders for isolation,
quarantine, or exclusion would
result, the Division may, upon
9request, allow employees to
return to work on the basis that
the removal of an employee
would create undue risk to a
community’s health and safety. In
such cases, the employer shall
develop, implement, and maintain
effective control measures to
prevent transmission in the
workplace including providing
isolation for the employee at the
workplace, and if isolation is not
feasible, the use of respirators in
the workplace.
Notify school community
including staff and parents of a
new positive case. Notification to
indicate the date the school was
informed of the positive case and
the number of new positive cases
that day without releasing
information that would identify
whether the positive case was a
student or staff member or what
grade or class was involved.
10. Teacher or Follow CalOSHA ETS and #9 for school employees who
staff or volunteer either test positive for COVID-19 or are awaiting evaluation
(school employee) for COVID-19 symptoms. COVID-19 symptoms means fever
has symptoms. of 100.4 degrees Fahrenheit or higher, chills, cough,
shortness of breath or difficulty breathing, fatigue, muscle or
body aches, headache, new loss of taste or smell, sore
throat, congestion or runny nose, nausea or vomiting, or
diarrhea, unless a licensed health care professional
determines the person’s symptoms were caused by a known
condition other than COVID-19.
11. Student feels Student to remain at home for 10/1. The 10 days begins on Recommend evaluation and
ill with COVID-19 the day the symptoms began. testing with physician, nurse
symptoms, but practitioner, or other licensed
parent/guardian If symptoms persist beyond 10 days, student to remain at medical professional practicing
will NOT be home until at least 1 day after symptoms have resolved under the license of a physician
testing child. without the use of medication OR if a licensed health care for index case, and household
provider determines that symptoms are not new, or members to quarantine as
worsening based on a chronic medical condition OR if a described in #1.
licensed health care provider has made an alternative Notify teacher of symptomatic
diagnosis based on a diagnostic test such as a positive strep student and to monitor class to
screen or a positive screen for influenza. determine if others become ill.
If second confirmed or suspected
case in classroom, school to
identify close contacts in
classroom and other school
settings in the two days prior to
illness up to the time the student
was last in class, including key
contributing factors. Identify close
contacts with symptoms and
10advise them to follow modified
quarantine or quarantine
guidance as described in #1
above, and if symptoms occur,
immediately self-isolate and
contact their local public health
department or physician, nurse
practitioner, or other licensed
medical professional practicing
under the license of a physician
and seek evaluation and testing
to guide further isolation
recommendations.
If student tests positive for
COVID-19, identify and notify
close contacts, school community,
and FCDPH liaison.
12. Student tests Student to remain at home while symptoms persist Recommend evaluation and
negative but has consistent with screening protocols at school. Ok to return testing with physician, nurse
COVID-19 to school after negative COVID-19 test (PCR or rapid practitioner, or other licensed
symptoms antigen) AND all symptoms have resolved without the use of medical professional practicing
(possible false medications OR if a physician, nurse practitioner, or other under the license of a physician
negative). licensed medical professional practicing under the license of for index case.
a physician determines that symptoms are not new, or
worsening based on a chronic medical condition OR if a Notify teacher of symptomatic
licensed health care provider has made an alternative student and to monitor class to
diagnosis based on a diagnostic test such as a positive strep determine if others become ill.
screen or a positive screen for influenza.
If second confirmed or suspected
case in classroom, school to
identify close contacts in
classroom and other school
settings in the two days prior to
illness up to the time the student
was last in class, including key
contributing factors. Close
contacts to follow modified
quarantine or quarantine
guidance as described in #1
above, and if symptoms occur,
immediately self-isolate and
contact their local public health
department or physician, nurse
practitioner, or other licensed
medical professional practicing
under the license of a physician
and seek evaluation and testing
to guide further isolation
recommendations.
13. AM PM Kindergarten sharing classroom with AM class with See scenario #1, #5, and/or #8
Kindergarten positive case shall move class to another location on the day above.
student or teacher of notification unless classroom cleaned since index case
tests positive. tested positive.
See scenario #1 and/or #8 regarding student tests positive
for additional guidance, or #5 if teacher tests positive.
1114. Outbreak of Report all positive cases identified by the school to FCDPH FCDPH recommends classroom
cases on campus. immediately per CCR Title 17. Evaluate all situations when closure for those schools where 2
two or more positive cases in a classroom are identified, or 3 or more students in a classroom
or more positive cases within a 2-week period on a school with no alternative source of
campus to determine source of spread consistent with CDPH transmission is identified,
guidance. Consult with FCDPH, as needed. particularly in middle and high
schools where students are
moving from classroom to
classroom. Consider classroom or
school shutdown on a case-by-
case basis in coordination with
FCDPH and consistent with CDPH
guidance.
15. What should a Recommend request documentation of a medical, mental
school do if a health, or disability exemption from a physician, nurse
student is not practitioner, or other licensed medical professional practicing
wearing a face under the license of a physician based on a diagnosis that is
covering? documented in their medical record to not wear a face
covering. Students with a medical exemption from a licensed
health care provider based on a diagnosis that is
documented in their medical record to not wear a face
covering are expected to wear a face shield with a drape.
16. What should a Verify that a physician, nurse practitioner, or other licensed
school do if a medical professional practicing under the license of a
student has a physician has determined that the student is medically
medical exemption exempt from wearing both a mask as well as face shield and
from a licensed drape. If there is a medical exemption for both a mask as
health care well as a face shield and drape from a physician, nurse
provider to not practitioner, or other licensed medical professional practicing
wear a face under the license of a physician that is based on a diagnosis
covering and is documented in their medical record, consider assigning
not wearing a face students to sit in seats that are physically distanced from
shield and drape? others in the classroom.
17. What should a See scenario #16 and #17 above
school do for
students in TK to
second grade if
the student is not
wearing a face
covering or a face
shield and drape?
18. What should a Consider alternative educational models other than in-person
school do if a classroom instruction.
student engages
in high-risk
behaviors such as
speaking loudly,
yelling, or singing
without a mask or
face shield with
drape, or not
following
directions to
12maintain physical
distancing?
19. What if a FCDPH Health Officer Order of 6-28-2021 requires
student or staff individuals with new or worsening COVID-19 symptoms to
member has a isolate as described in #2. Students and staff members with
chronic condition a chronic condition that in the opinion of a physician, nurse
causing one of the practitioner, or other licensed medical professional practicing
COVID-19 under the license of a physician is causing one of the COVID-
symptoms? 19 symptoms can return to school if they have a note from a
physician, nurse practitioner, or other licensed medical
professional practicing under the license of a physician
indicating that their symptoms are related to a chronic
condition and are not new or worsening.
The physician, nurse practitioner, or other licensed medical
professional practicing under the license of a physician
should document in their medical record the chronic
condition that is the basis for the symptom(s) in question. If
a student or staff member has recurrence of similar
symptoms related to the same chronic condition on a later
date, schools should consider both symptoms and prior
notes written by a physician, nurse practitioner, or other
licensed medical professional practicing under the license of
a physician when determining next steps.
Students or teachers who have fever, cough, or shortness of
breath when they are screened upon entry to school or
during school should be advised to stay at home or return to
home until their symptoms have resolved even if they have
been diagnosed with a chronic condition that in the opinion
of a physician, nurse practitioner, or other licensed medical
professional practicing under the license of a physician is
causing one of the COVID-19 symptoms.
20. Student or If student or school employee was
teacher staff or previously diagnosed with
volunteer (school laboratory-confirmed COVID-19
employee) had and has remained asymptomatic
documented and after recovery, retesting or
test-confirmed quarantine is not recommended if
COVID-19 in past another exposure occurs or might
90 days and is a have occurred within 90 days
close contact. after the date of symptom onset
from the initial SARS-CoV-2
infection.
21. What if a Students or staff members may also return to school sooner
student or staff than 10 days if their symptoms have resolved and if a
member has one physician, nurse practitioner, or other licensed medical
of the COVID-19 professional practicing under the license of a physician has
symptoms but has determined that the cause for their symptoms is due to
been diagnosed another infectious process or medical condition that is
with another confirmed by diagnostic testing, such as a positive strep test
infectious disease for sore throat, or a positive influenza test for flu symptoms.
or medical Students or teachers who have fever, cough, or shortness of
condition? breath when they are screened upon entry to school or
during school should be advised to stay at home or return to
home until their symptoms have resolved even if they have
been diagnosed with a condition other than COVID-19.
1322. Can school Quarantine guidance for school nurses falls under CalOSHA
nurses that are Emergency Temporary Standards.
identified as close
contacts
quarantine under
the health care
worker guidance?
23. Are there any Dances in particular are considered higher risk activities
requirements for because they can involve direct physical contact similar to
schools that are high-risk sports. CDPH includes the following consideration
planning for for K-12 school dances and large assemblies; “Ensure all
indoor dances or eligible attendees (students and adults) are fully vaccinated.
large assemblies? Conduct pre-entry testing for all unvaccinated attendees at
or just prior to the event.”
For these reasons and to protect the health and safety of all
attendees at events that are high risk for the transmission of
COVID-19, FCDPH strongly encourages all schools to screen
for completed vaccination status for all K-12 dance
participants, and to ensure that all participants who are not
fully vaccinated have had a negative COVID-19 test (PCR or
rapid antigen) within 72 hours of the dance. CDPH masking
requirements in K-12 schools remain in place during dances
and large assemblies.
Indoor events where more than 1000 attendees are
expected, follow CDPH guidance for indoor mega-events.
https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-
19/Beyond-Blueprint-Framework.aspx
Transportation Services
Scenario Response and Isolation Steps Communication and Contact Tracing Steps
24. Bus driver or Refer to #1 or #9 above. Refer to #1 or #9 above. Conduct contact
student rider on bus tracing consistent with guidance for school
tests positive scenarios described above, paying attention
to key contributing factors. Consult with
FCDPH if questions regarding determining
close contacts on bus.
14After school programs
Scenario Response and Isolation Steps Communication and Contact Tracing Steps
25. Student or teacher Ensure availability of space to isolate Conduct contact tracing consistent with
or staff tests positive, children or staff with symptoms, with staff guidance for school scenarios described
or has symptoms person with appropriate PPE available to above, while determining if any close contacts
monitor while awaiting disposition to home in alternative settings utilized by after-care
or for higher level of care consistent with program.
guidance in above scenarios.
If any close contacts with symptoms identified,
Refer to #1, #3, and/or #8 above. consider key contributing factors and notify
FCDPH.
Refer to #1, #3, and/or #8 above.
Notify school community of positive cases.
Definitions:
COVID-19 Symptoms: People with COVID-19 have had a wide range of symptoms reported – ranging from
mild symptoms to severe illness. Symptoms may appear 2-14 days after exposure to the virus. Anyone can
have mild to severe symptoms. People with these symptoms may have COVID-19:
• Fever or chills
• Cough
• Shortness of breath or difficulty breathing
• Fatigue
• Muscle or body aches
• Headache
• New loss of taste or smell
• Sore throat
• Congestion or runny nose
• Nausea or vomiting
• Diarrhea
Symptoms of COVID-19 | CDC
A person who had a documented case of COVID-19 and whose isolation period ended (including being
asymptomatic for at least one day) and who then develops new symptoms consistent with COVID-19 during
the 90 days after the date of initial symptom onset, likely warrants additional testing unless an alternative
etiology can be or has been readily identified by a healthcare provider.
Testing: Both PCR and rapid antigen tests are available and can be used in school settings to determine if
COVID-19 is present or absent. PCR is considered the, “gold standard”. If both a rapid antigen and a PCR test
are done on the same day and have different results, the PCR result should determine if the individual who is
tested has COVID-19. If the rapid antigen and PCR tests are done on different days, the result from the first
COVID-19 test should be used to determine COVID-19 status. Home tests may be considered when
determining COVID-19 status if there is a mechanism for school personnel to verify the test result, such as
through direct observation. Positive COVID-19 home test results entered by schools into State of California
data bases such as CalConnect will be accepted as true positives. For more information regarding testing,
please refer to CDPH COVID-19 testing guidance.
https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/Updated-COVID-19-Testing-Guidance.aspx
10/1: Current CDC guidelines state that the index case must self-isolate for at least 10 days from the date
symptoms began (for symptomatic patients) OR at least 10 days from the day the positive test was collected,
15PLUS one day with no symptoms without the use of medications. If index case has serious underlying medical
conditions, contact FCDPH for consultation regarding isolation period.
Index case: person with a positive COVID-19 test. In these scenarios, index case also refers to the person
(student, teacher, or staff) who reports symptoms.
Close contact*: Close contact is defined as someone who has been within 6 feet of an infected person for a
total of 15 minutes or more over a 24-hour period, cumulative time, during the infectious period. For the
purposes of determining a close contact, cumulative time is defined as the period of time of exposure to
ANY/ALL COVID-19 positive person(s), and is calculated as 15 minutes or more of time where a close contact
has been in contact to a person(s) positive with COVID-19 while that person(s) was infectious, i.e. 2 days prior
to symptom onset while symptomatic, or 2 days prior to test date if asymptomatic, up to the last contact with
the COVID-19 positive person(s). The close contact definition applies in both the indoor and outdoor settings.
If questions about whether an individual meets the criteria for a close contact, refer to key contributing factors.
Refer additional questions regarding close contact criteria to FCDPH.
Outbreak: Two or more confirmed COVID-19 positive cases in a classroom OR three or more confirmed
COVID-19 positive cases on the school campus within 14 days.
Quarantine: Applies in both indoor and Separates individuals who are close contacts of a confirmed COVID-
19 positive case but who are not yet ill. Individuals who are close contacts and asymptomatic may discontinue
quarantine after Day 10 from the date of last exposure without testing. Household close contacts quarantine
for 10 days after last close contact with index case while they are in isolation. All contacts released from
quarantine before Day 14 must Self-monitor for COVID-19 symptoms through Day 14 and if symptoms occur,
immediately self-isolate and contact their local public health department or healthcare provider and seek
testing.
School nurses may return to work during staffing shortages after Day 7 from the date of last exposure with a
PCR test performed after Day 5 and a negative result. After this time, contacts must use surgical face masks at
all times during work and continue to use face coverings when outside the home through Day 14 after last
exposure.
1. Modified Quarantine: When both parties were wearing a mask in the indoor classroom setting,
unvaccinated students who are close contacts (more than 15 minutes over a 24-hour period within 0-
6 feet indoors) may undergo a modified 10-day quarantine as follows. They may continue to attend
school for in-person instruction if they:
i. Are asymptomatic;
ii. Continue to appropriately mask, as required;
iii. Undergo at least twice weekly testing during the 10-day quarantine; and
iv. Continue to quarantine for all extracurricular activities at school, including sports, and
activities within the community setting.
v. Quarantine can end after Day 7 if a diagnostic specimen is collected after Day 5 from the
date of last exposure and tests negative.
Modified quarantine or quarantine can end after Day 7 if a diagnostic specimen is collected after Day 5 from
the date of last exposure and tests negative as described in scenario #1.
Isolation: Separates infected people who have a confirmed COVID-19 test from others. Symptomatic COVID-
19 positive individuals must isolate for a minimum of 10 days from onset of symptoms and at least one day
without fever and an improvement in respiratory symptoms. Asymptomatic COVID-19 positive individuals
must isolate for 10 days from test collection date.
16Covid-19 School Scenario Guidance
Potential Scenarios Key Contributing Factors Potential Responses/Actions
□ Student has tested positive for □ Was index case wearing mask □ Notify school community of
COVID-19 properly? COVID positive cases in the
child’s classroom or school
□ Student feels ill and is waiting □ Was social distancing
for test results maintained? □ Complete contact tracing
□ Student develops COVID □ Duration of exposure to index □ Quarantine close contacts
symptoms while at school case.
□ Inform potential close contacts
□ COVID-19 confirmed or to self-monitor, follow up with
□Member of student’s household suspected physician if symptoms develop.
tests positive
□ Index case symptomatic or □ Sanitize and disinfect
□ Teacher tests positive asymptomatic potentially contaminated
equipment, supplies, and rooms
□ Student feels ill with COVID □ Location of exposure -
symptoms but parent will not classroom, outdoors, other □ Close classroom
be testing child indoor setting
□ Contact the Fresno County
□ Student tests negative but has □ Proper PPE used? Department of Public Health (FC
COVID symptoms (possible DPH)
false negative) □ Prior positive cases in
classroom? □ Recommend testing if not
□ Administrator or staff member, already done
or volunteer tests positive □ Prior positive cases on school
campus? □ Recommend evaluation from
□ Administrator or staff, or physician
volunteer feels ill with COVID
symptoms □ Type of transportation to and □ Follow up contact with index
from school case and/or close contacts
□ AM Kindergarten student or scheduled
teacher tests positive □Windows open or closed on
bus
□ Outbreak of cases on campus
□ Presumed source of spread to
□ Bus driver, or student rider on index case-school vs community
bus, tests positive
□ Household contacts at other
□ Student or teacher in after schools
school program tests positive
□ Close contacts in school sports
or other after-school programs
17Sample Notification Letter – Symptoms
Dear Parent or Guardian:
Coronavirus (COVID-19) is an illness caused by a virus that can spread from person to person. The virus
that causes COVID-19 is a new coronavirus that has spread throughout the world. COVID-19 symptoms
can range from mild (or no symptoms) to severe illness. You can become infected by coming into close
contact (about 6 feet or two arm lengths) with a person who has COVID-19. COVID-19 is primarily spread
from person to person. You can become infected from respiratory droplets when an infected person
coughs, sneezes, or talks. You may also be able to get it by touching a surface or object that has the virus
on it, and then by touching your mouth, nose, or eyes.
Because your student has symptoms of COVID-19 and because your school wants to protect your
student’s health and the health of others, your student cannot return to school until the following are
true:
1. Your student had a negative test result for COVID-19 and has no further symptoms. Be
prepared to show proof of either a negative PCR or rapid antigen COVID-19 test.
OR
2. At least 10 days have passed from the day symptoms were first identified
AND
At least 24 hours without symptoms and fever free without fever reducing medication.
3. If your student has a chronic condition that in the opinion of a licensed health care
provider is causing one of the COVID-19 symptoms, they can return to school if they
have a note from a licensed health care provider indicating that their symptoms are
related to a chronic condition and are not new or worsening.
4. If a health care provider has made an alternative diagnosis based on a diagnostic test
such as a positive strep screen or a positive screen for influenza, they may stop isolation
after improvement of symptoms for 24 hours without the use of fever reducing
medications.
COVID-19 and other illnesses are potentially very serious. Please consult your medical provider for any
questions you may have regarding your student’s condition or testing. If your student has symptoms
that are worsening, particularly any trouble breathing, continued pain or pressure in the chest, or bluish
lips or face, immediately contact your medical provider or go to the emergency room or call 911.
If you do not have a negative COVID-19 test for your student, the earliest date your ill student can return
is ___________________________ (NOTE: Calculate based on 10 days from date symptoms were
identified)
In addition, any other students living in the household of the sick student may not return for 10 days
after the last day they were in contact with the ill child, or they may return on or after 7 days if they
remain asymptomatic and have a negative COVID-19 test on or after day 5. Other students living in the
household may return if the sick student is cleared to return prior to 10 days for one of the reasons
noted above.
Names of other students in house: _______________________________________________________
12/15/2021Return to school date if able to isolate other students from your student: __________ (NOTE: Calculate
based on 10 days from last date of close contact with index case. Recommend follow-up to determine if
close contact was able to remain quarantined from index case- if not will need to extend date of return
to school to end of isolation period for index case, plus additional 10 days of quarantine)
Staff name: ___________________________________________________________
For additional information on isolation and quarantine, please visit the Fresno County Department of
Public Health webpage at: www.fcdph.org/covid19orders
Please contact the site health service staff if you have questions regarding returning.
12/15/2021Sample Notification Letter – Exposure- Modified Quarantine
Dear Parent or Guardian:
Your student may have been exposed to COVID-19 on ___________________ at ___________________.
Coronavirus (COVID-19) is an illness caused by a virus that can spread from person to person. The virus
that causes COVID-19 is a new coronavirus that has spread throughout the world. COVID-19 symptoms
can range from mild (or no symptoms) to severe illness. You can become infected by coming into close
contact (about 6 feet or two arm lengths) with a person who has COVID-19. COVID-19 is primarily
spread from person to person. You can become infected from respiratory droplets when an infected
person coughs, sneezes, or talks. You may also be able to get it by touching a surface or object that has
the virus on it, and then by touching your mouth, nose, or eyes.
We have determined that both the person who had COVID-19 and your student were wearing a mask. In
this circumstance, _________________________ and the Fresno County Department of Public Health
requires the following steps:
Your student may continue to attend school for in-person instruction if they:
i. Do not have any symptoms of COVID-19;
ii. Continue to mask as required indoors and outdoors if less than six feet from others;
iii. Undergo at least twice weekly testing for 10-days; and
iv. Do not participate in all extracurricular activities at school, including sports, and activities within
the community setting for 10 days (__________).
Alternatively, your student may complete their testing and return to extracurricular activities after Day 7
(______________) if a COVID-19 test is collected on or after Day 5 (___________) from the date of last
exposure and if they test negative.
If you decide that you do not want your student to be tested, your student must quarantine by staying
at home for 10 days from the last day of their exposure (__________).
Whether your student is tested or not, they are expected to:
i. Continue daily self-monitoring for symptoms through Day 14 from last known exposure;
AND
ii. Follow all other recommended steps to stop the spread of COVID-19 including wearing a
mask when around others, hand washing, and avoiding crowds through Day 14 from last
known exposure.
iii. If any symptoms develop during this 14-day period, your student should immediately
isolate, get tested and contact their healthcare provider with any questions regarding their
care
People with COVID-19 have had a wide range of symptoms reported – ranging from mild symptoms to
severe illness. Symptoms may appear 2-14 days after exposure to the virus. People with these
symptoms may have COVID-19:
12/15/2021• Fever or chills
• Cough
• Shortness of breath or difficulty breathing
• Fatigue
• Muscle or body aches
• Headache
• New loss of taste or smell
• Sore throat
• Congestion or runny nose
• Nausea or vomiting
• Diarrhea
o If any of these symptoms develop,
i. Contact your medical provider for evaluation or go to the emergency room if
getting worse or trouble breathing. The medical provider may or may not
recommend testing for COVID-19.
ii. Student must be isolated, as much as possible, from the rest of the household.
iii. Student may return to school after being completely symptom free for 24 hours
without the use of medication, AND a minimum of 10 days have passed since
the symptoms began, which may extend the quarantine period beyond the
original 10 days.
iv. Notify the school of any changes in status.
If your student is confirmed positive for COVID 19, please follow these guidelines:
1. Your student must be isolated, as much as possible, from the rest of the household.
2. We recommend evaluation by your student’s medical provider if their symptoms worsen or go
to the emergency room if any trouble breathing.
3. Any other children or adults in the household are now considered close contacts and must
quarantine for 10 days.
4. Any other close contacts may end quarantine as described above after Day 7 (______________)
if they remain asymptomatic and if they test negative for COVID-19 on or after Day 5
(___________).
a. If any household contacts develop symptoms during the 10 days, please contact your
physician for evaluation. The physician may or may not recommend testing for COVID-
19.
5. Your student may return to school after being completely symptom free for 24 hours without
the use of medication, AND a minimum of 10 days have passed since the symptoms began OR
when the positive test was completed.
6. Notify the school(s) of any changes in status.
If you have general questions about COVID-19, you can visit the Fresno County Department of Public
Health webpage at www.fcdph.org/covid19.
If you need resources, please contact ____________________.
If you would like to speak to someone on the school campus, please contact ______________________.
12/15/2021Sample Notification Letter for Positive Case
Dear Parent or Guardian:
Your student had a positive COVID-19 test.
Coronavirus (COVID-19) is an illness caused by a virus that can spread from person to person. The virus
that causes COVID-19 is a new coronavirus that has spread throughout the world. COVID-19 symptoms
can range from mild (or no symptoms) to severe illness. You can become infected by coming into close
contact (about 6 feet or two arm lengths) with a person who has COVID-19. COVID-19 is primarily spread
from person to person. You can become infected from respiratory droplets when an infected person
coughs, sneezes, or talks. You may also be able to get it by touching a surface or object that has the virus
on it, and then by touching your mouth, nose, or eyes.
___________________________ and the Fresno County Department of Public Health recommend the
following steps:
1. Your student is required to self-isolate at home, including complete separation from others in
the house. This means no contact, no time together in the same room, and no sharing of any
spaces, such as the same bathroom or bedroom.
2. Your student may return to school:
a. After being completely symptom-free for 24 hours without the use of medication,
b. AND a minimum of 10 days have passed since the symptoms began OR when the
positive test was completed. Based on the information we collected, the date your
student may return to school is ___________.
3. Any other students or adults in the household are now considered close contacts and must
quarantine for 10 days.
a. Quarantine for 10 days following date of last exposure to the student with a positive
COVID-19 test, including complete separation from the person in your house with
COVID-19.
i. Alternatively, quarantine for close contacts may end after Day 7 from the date
of last exposure (______________) if they remain asymptomatic and if they test
negative for COVID-19 on or after Day 5 (___________).
ii. If unable to completely separate from student with COVID-19, any other
students or adults in the household must quarantine for 10 days after the last
contact with the student with COVID-19 during their isolation period.
b. If any household contacts develop symptoms during the 10 days, they should contact
their medical provider for evaluation. The medical provider may or may not recommend
testing for COVID-19.
4. We recommend evaluation by your student’s medical provider if you have any questions or if
their symptoms worsen or go to the emergency room or call 911 if your student has any trouble
breathing, continued pain or pressure in the chest, or bluish lips or face.
5. Notify the school(s) of any changes in status.
12/15/2021If you have general questions about COVID-19, you can visit the Fresno County Department of Public
Health webpage at www.fcdph.org/covid19.
If you need resources, please contact __________________.
If you would like to speak to someone on the school campus, please contact ______________________.
12/15/2021County of Fresno
DEPARTMENT OF PUBLIC HEALTH
David Luchini, Director
Dr. Rais Vohra, Interim Health Officer
Health Update
December 15, 2021
Evaluating Workers or Students with COVID-19 Symptoms
To protect the health and well-being of everyone in the workplace or classroom, the Fresno County Department of
Public Health (FCDPH) has required that workers or students with COVID-19 symptoms isolate for 10 days and that
health care providers have the ability to test for COVID-19.
This health message provides updated information to the Health Update dated March 25, 2021 and includes
information on using rapid antigen testing.
The FCDPH strongly encourages you to do a COVID-19 test on any individual with COVID-19 symptoms. In ambulatory
settings (as opposed to hospitals, skilled nursing facilities, or high-risk congregate settings) either rapid antigen tests or
molecular tests such as PCR are acceptable to determine both the presence or absence of active infection with SARS-
CoV-2 in individuals with or without symptoms. Repeat antigen testing and/or confirmatory molecular testing should be
considered in individuals who receive a negative result with an antigen test but have symptoms specific for COVID-19
(such as loss of taste and smell). https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/Updated-COVID-19-
Testing-Guidance.aspx If an individual tests negative for COVID-19, they can return to their place of work or school
once symptoms have improved and they have had no fever for 24 hours without any medication use.
Your patient may have a chronic condition that is causing COVID-19 like symptoms. Symptoms of COVID-19 includes new
or worsening presence of the following:
• Fever or chills
• Cough
• Shortness of breath or difficulty breathing
• Congestion or runny nose
• Fatigue
• Repeated shaking/ tremors
• Muscle pains or body aches
• Headache
Categories of Health Alert Messages:
Health Alert: Conveys the highest level of importance; warrants immediate action or attention
Health Advisory: Provides important information for a specific incident or situation; may not require immediate action
Health Update: Provides updated information regarding an incident or situation; unlikely to require immediate action
Health Information: Provides general health information which is not considered to be of emergent nature
Promotion, preservation and protection of the community’s health
1221 Fulton Street, Fresno, CA 93721 P.O. Box 11867, Fresno, CA 93775
(559) 600-3200 FAX (559) 600-7687
The County of Fresno is an Equal Employment Opportunity Employer
www.co.fresno.ca.us www.fcdph.org
Page 1 of 2Health Update
December 15, 2021
Evaluating Workers or Students with COVID-19 Symptoms
• Sore throat
• New loss of taste or smell
• Nausea, vomiting or diarrhea
As a licensed health care provider, you can determine that your patient’s symptoms are not new, or worsening based on
a chronic medical condition. If this is the case, we ask that you provide a note for their school or workplace stating that
your patient has a chronic condition and indicate the symptoms that it may be causing. As a licensed health care
provider, you may also make an alternative diagnosis based on a diagnostic test such as a positive strep screen or
influenza screen to explain your patient’s symptoms and clarify that on the note.
We want our workplaces to remain open and our children to return to school. If there is someone with COVID-19
symptoms in the workplace or classroom, co-workers, teachers and classmates are understandably very concerned.
Testing all individuals with COVID-19 symptoms will help alleviate these concerns and help us control this pandemic.
Thank you for ensuring the health and safety of your patient as well as the health and safety of the other children and
staff they encounter at school and in our community.
If you have questions about COVID-19 or COVID-19 testing, you may contact the Fresno County Department of Public
Health at (559) 600-3332.
For COVID-19 testing events in Fresno County, visit www.fcdph.org/covid19testing.
###
Page 2 of 2Important Information for Health Care Providers when
Evaluating Workers or Students with COVID-19 Symptoms
This worker or student or staff was unable to attend work or school because they developed new or worsening
symptoms of COVID-19.
Symptoms of COVID-19 includes the new or worsening presence of the following:
• Fever or chills • Muscle pains or body aches
• Cough • Headache
• Shortness of breath or difficulty breathing • Sore throat
• Congestion or runny nose • New loss of taste or smell
• Fatigue • Nausea, vomiting or diarrhea
• Repeated shaking/tremors
To protect the health and well-being of everyone in the workplace or classroom, the Fresno County Department of
Public Health requires that workers or students with COVID-19 symptoms isolate for 10 days.
We strongly encourage you to do a COVID-19 test, either PCR or rapid antigen, on any individual with
COVID-19 symptoms. If an individual tests negative for COVID-19, they can return to their place of work or
school once symptoms have improved and they have had no fever for 24 hours without any medication use.
Your patient may have a chronic condition that is causing COVID-19 like symptoms. As a licensed health
care provider, you can determine that your patient’s symptoms are not new, or worsening based on a
chronic medical condition. As a licensed health care provider, you may also make an alternative diagnosis based on
a diagnostic test such as a positive strep screen or influenza screen to explain your patient’s symptoms.
Please indicate below how you determined if your patient’s symptoms were related to COVID-19.
At least one of the three lines below must be completed for this form to be accepted.
Patient’s name: _____________________________________ Date of evaluation: ________________
1) COVID-19 Test: PCR: ☐ Rapid Antigen: ☐
COVID-19 Test Result: Positive: ☐ Negative: ☐ Date of Test: ________________
2) If patient has chronic medical condition explaining the COVID-like symptom, indicate symptom and chronic
medical condition below:
COVID-Like Symptom: _________________________________________________________
Chronic Medical Condition: ______________________________________________________
3) If patient has an alternative diagnosis based on a diagnostic test, indicate alternative diagnosis and
diagnostic test below:
Alternative diagnosis: ______________________________ Diagnostic test: _______________
He/she may return to school/work as noted: Yes: ☒ No: ☐ Date: ____________________
If you have questions about COVID-19 or COVID-19 testing, you may contact the Fresno County Department of
Public Health at (559) 600-3310. Thank you for ensuring the health and safety of your patient as well as the health
and safety of the other children and staff they come into contact with at school and in our community.
Provider Name Printed: _______________________________
Provider Signature: __________________________________ Date: _________________
Provider Phone Number: _____________________________ FAX: _________________
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